EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†

Bibtex

@article{4ee73d896b144d4baf0637c3e3a623f9,

title = "EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†",

abstract = "BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SETTING: Online Delphi survey and consensus conference.PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70{\%} agreement and ≤15{\%} disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28{\%}) statements achieved level 1 consensus and 49 (42{\%}) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81{\%}) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.",

author = "A Horwich and M Babjuk and J Bellmunt and Bruins, {H M} and Reijke, {T M De} and Santis, {M De} and S Gillessen and N James and S Maclennan and J Palou and T Powles and Ribal, {M J} and Shariat, {S F} and Kwast, {T Van Der} and E Xylinas and N Agarwal and T Arends and A Bamias and A Birtle and Black, {P C} and Bochner, {B H} and M Bolla and Boormans, {J L} and A Bossi and A Briganti and I Brummelhuis and M Burger and D Castellano and R Cathomas and A Chiti and A Choudhury and E Comp{\'e}rat and S Crabb and S Culine and Bari, {B De} and Blok, {W De} and {De Visschere}, {P J L} and K Decaestecker and K Dimitropoulos and Dominguez-Escrig, {J L} and S Fanti and V Fonteyne and M Frydenberg and Futterer, {J J} and G Gakis and B Geavlete and P Gontero and B Grubm{\"u}ller and S Hafeez and Hansel, {D E} and A Hartmann and D Hayne and Henry, {A M} and V Hernandez and H Herr and K Herrmann and P Hoskin and J Huguet and Jereczek-Fossa, {B A} and R Jones and Kamat, {A M} and V Khoo and Kiltie, {A E} and S Krege and S Ladoire and Lara, {P C} and A Leliveld and E Linares-Espin{\'o}s and V L{\o}gager and A Lorch and Y Loriot and R Meijer and Mir, {M Carmen} and M Moschini and H Mostafid and A-C M{\"u}ller and M{\"u}ller, {C R} and J N'Dow and A Necchi and Y Neuzillet and Oddens, {J R} and J Oldenburg and S Osanto and Oyen, {W J G} and L Pacheco-Figueiredo and H Pappot and Patel, {M I} and Pieters, {B R} and K Plass and M Remzi and M Retz and J Richenberg and M Rink and F Roghmann and Rosenberg, {J E} and M Roupr{\^e}t and O Rouvi{\`e}re and C Salembier and A Salminen and P Sargos and S Sengupta and A Sherif and Smeenk, {R J} and A Smits and A Stenzl and Thalmann, {G N} and B Tombal and B Turkbey and Lauridsen, {S Vahr} and R Valdagni and {Van Der Heijden}, {A G} and {Van Poppel}, H and Vartolomei, {M D} and E Veskim{\"a}e and A Vilaseca and Rivera, {F A Vives} and T Wiegel and P Wiklund and A Williams and R Zigeuner and Witjes, {J A}",

note = "{\circledC} The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.",

N2 - BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SETTING: Online Delphi survey and consensus conference.PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.

AB - BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.SETTING: Online Delphi survey and consensus conference.PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.CONCLUSIONS: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.